Bosa Technology (Hong Kong) Ltd
Sales & Marketing Department
Ph/Fax: (852) 2505 5568
PURCHASE ORDER FORM - SERVISPLICE MECHANICAL COUPER SYSTEM (TYPE I - NON-DUCTILITY COUPLER)
CUSTOMER INFORMATION
DELIVERY INFORMATION
Order Reference
Delivery Date :
Expected Completion Date :
Company
Office Use Only
Tel/Fax
BOSA Reference
Project Name
Estimated Lead Time
Representative
Estimated Freight
ITEM
REBAR SIZE (MM)
LENGTH (MM)
TYPE OF COUPLER
DESCRIPTION
QTY (NOS)
REMARKS
1
2
3
4
5
6
7
8
9
10
TYPE OF COUPLER (A / B / C)
A
(Two Standard Thread (#1) with one
Servisplice Standard Normal Coupler)
B
(One Standard Thread (#1), One Extended Thread
(#2) with one Servisplice Standard Normal Coupler)
C
(One Standard Thread (#1), One Extended Thread
(#3) with one Servisplice Standard Normal Coupler
and Lock nut)
A
(One Standard Thread (#1)with one
Servisplice Standard Normal Coupler)
B
(One Extended Thread (#2) with one Servisplice
Standard Normal Coupler)
C
(One Extended Thread (#3) with one Servisplice
Standard Normal Coupler and Lock nut)
(One Standard Thread (#1) Only)
Authorized signature with company chop :
(One Extended Thread (#2) / (#3) Only)
Date :
(Servisplice Standard Normal Coupler Only)
(Page : QR-0408/0/18.12.2012
)